QAS Adrenaline DTP

Vocabulary and dosage flashcards covering pharmacology, indications, contraindications, pharmacokinetics, and adult and paediatric dosing regimens for adrenaline (epinephrine) according to Queensland Ambulance Service guidelines.

Drug class

Sympathomimetic.

Pharmacology

Naturally occurring catecholamine that primarily acts on Alpha (a) and Beta (B) adrenergic receptors. B1 receptors produce an increase in heart rate, an increase in the force of myocardial contraction, and an increase in the irritability of the ventricles. B2 produce bronchodilation and a1 produce peripheral vasoconstriction.

Metabolism

Predominantly metabolised by sympathetic nerve endings via mitochondrial enzymatic breakdown by monoamine oxidase at the synaptic level.

Indications

1. Cardiac arrest

2. Anaphylaxis

3. Severe life-threatening bronchospasm OR silent chest (able to speak in single words AND/OR hemodynamic compromise AND/OR an ALOC)

4. Shock unresponsive to adequate fluid resuscitation

5. Bradycardia with poor perfusion (unresponsive to atropine and/or transcutaneous pacing)

6. Moderate to severe croup.

Contraindications

Nil.

Precautions

1. Hypertension

2. Hypovolaemic shock

3. Concurrent MAOI therapy

4. Quetiapine toxicity.

Side Effects

1. Anxiety

2. Hypertension

3. Palpitations/tachyarrhythmias

4. Pupil dilation, and tremor.

Presentation

1. Ampoules of 1mg/1ml (1:1000) and 1mg/10ml (1:10,000)

2. Pre-filled EpiPen Auto-injector (300microg)

3. Pre-filled EpiPen Jr Auto-injector (150microg)

Pharmacokinetics

Onset: 30 seconds(IV) or 60 seconds (IM)

Duration of 5-10 minutes

Half-life of 2 minutes

Adult Dosages

IM: 500microg repeated at 5 minute intervals, with no max dose. (anaphylaxis & severe life threatening bronchospasm)

NEB: 5mg single dose only (may be administered for upper airway obstruction that is refractory to 3×IM adrenaline injections)

IV:

1. 1mg, repeated 3-5 minutes, no max dose (cardiac arrest)

2. 20-50 microg, repeated at 1 minute intervals, no max dose (bradycardia)

IV inf: 20-50microg bolus, immediately followed by infusion at 10microg/minute (10ml/hr), titrated to indication and response. Max infusion rate 50microg/minute (50ml/hr) (anaphylaxis, severe life threatening bronchospasm, shock)

Prepared by mixing 3mg (3ml of 1:1000 adrenaline with 47ml of sodium chloride to achieve a final concentration of 60microg/ml. administered via Perfusor Space Medication Library Adrenaline-adult shock

Paediatric cardiac arrest dosages

IV/IO:

1. >1 year: 10microg/kg

2. 6-12 months: 100microg

3. 3-5 months: 70microg

4. 38wks gest-2 months: 50microg

5. 27-37wks gest: 25microg

6. <27wks gest: 10microg

All repeated every 3-5 minutes, no max dose

Paediatric other doses

IM:

1. >6 years: 300microg

2. 1-5 years: 150microg

3. 6MO-1 year: 100microg

4. <6MO: 50microg

All repeated 3-5 minutes, no max dose (anaphylaxis, severe life threatening bronchospasm)

NEB:

5mg, single dose only (anaphylaxis with upper airway obstruction refractory to X3 IM adrenaline and croup)

IV/IO:

1. 1microg/kg, single dose not to exceed 50 microg, repeated at 2 minute intervals, no max dose (shock)

2. Contact consult line for approval (bradycardia)

IV inf:

1. >6 years: 1microg/kg bolus, immediately followed by 0.2microg/kg/min (0.2ml/kg/he) titrated to indication and response, max infusion rate 0.5 microg/kg/hr. (anaphylaxis, severe life threatening bronchospasm unresponsive to X2 IM adrenaline.

2. <6 years: consult required for approval.

Prepared by mixing 3mg (3ml of 1:1000 adrenaline with 47ml of sodium chloride to achieve a final concentration of 60microg/ml. administered via Perfusor Space Medication Library Adrenaline-Paed shock